3.19 Treatment failure
Treatment failure is when your current treatment needs to be changed. This is usually if there is drug resistance.
Treatment failure is defined in different ways depending on the country you live in and the tests that are available.
Viral failure is defined as:
- Viral load never becoming undetectable in a certain time.
- Viral load becoming detectable after previously being undetectable.
Both cases show that ART might not be working.
Viral failure is not linked to feeling ill.
This is when you get symptoms (ie other illnesses). It means that the drugs are not stopping you from getting ill. This is called clinical failure.
How to manage treatment failure varies in different countries.
It depends on which test and drug choices are available.
Managing treatment failure
Before changing ART it is important to find out why treatment failed.
- Was this related to adherence?
- Or being given the wrong ART?
- Or that you have stopped taking ART?
- Is is because of drug resistance?
- Or because the treatment was not potent enough?
- Or because the drugs were being poorly absorbed.
Management of treatment failure depending on which country you live in. This is related to whether viral load tests are easily available..
- Viral failure is used to decide when to change ART in high-income countries. This is when there is access to viral load tests and/or there are several options for a new combination.
- Clinical failure is used to decide when to change treatment in some low- and middle-income countries (LMICs). This is when viral load tests are not available and/or there are limited options for a new combination.
When there are new treatment options, then changing all three drugs to a new combination is usually recommended.
Low level increases in viral load are often just blips (one-off unusual results) and often go down by themselves.
Blips do not count as treatment failure.
Virological failure usually occurs first. It can sometimes take months for this to lead to clinical failure.
Management of treatment failure is a specialised area, and approaches changes based on new research.
i-Base produce a detailed guide to changing treatment (August 2021).
This is a separate resource to the advocacy manual and is based on virological failure. It has been translated into other languages. Please check the data of any translation.
Last updated: 1 January 2023.